Hospitalisation in First-episode psychosis

The paper by Sipos et al (2001) was discussed with great enthusiasm in our evidence-based journal club. We learnt that 80% of patients with first-episode psychosis were hospitalised within 3 years of first contact with specialist services. Patients with manic symptoms at presentation were admitted rapidly; those with negative symptoms and longer duration of untreated illness were admitted later. The paper concluded that community-oriented psychiatric services might only delay, rather than prevent, admission of patients with a first-episode of psychosis.

At the end of the journal club we realised that the findings from this paper cannot be generalised to our patient group without the knowledge of certain other key issues not mentioned in the paper.

1. (a) Availability of in-patient beds: studies have shown that the utilisation of in-patient care is determined by the supply of available beds (Saarento et al, 1996).

2. (b) Availability of assertive community psychiatric services: an assertive community treatment programme has shown to be effective in reducing hospitalisation compared with clinical case management programmes (Ziguras & Stuart, 2000).

3. (c) A study by Lang et al (1999) demonstrates that improvement in social support predicted decline in hospitalisation.

4. (d) History of suicidal behaviour carries a greater risk of admission in first-episode psychosis and higher readmission rates over 2-year follow-up (Verdoux et al, 2001).

5. (e) In clinical practice a patient's willingness to accept treatment as an out-patient would be a factor in deciding about in-patient treatment.

In our opinion hospitalisation in first-episode psychosis would be greatly affected by the above issues and without knowledge of these issues, the findings from Sipos et al's study cannot be generalised to patient groups in other areas/services.